Optum Serve Medical Director - VA Community Care Network - Remote in US
Company: Optum
Location: San Diego
Posted on: May 12, 2025
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Job Description:
For those who want to invent the future of health care, here's
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Caring. Connecting. Growing together.
Optum Serve is part of the family of companies that make
UnitedHealth Group, one of the leaders across the US healthcare
system. -Optum Community Care Services (CCS) sits within Optum
Serve supporting federal contracts such as the Veterans
Administration Community Care Network (VA CCN) which provides a
network of community care providers to serve Veterans.
The Optum Community Care Services (CCS) Medical Director works
diligently to oversee clinical quality provided from community care
providers to Veterans. The medical director will work
collaboratively with the Patient Safety Specialists in reviewing
medical records and determining applicable standards of care. The
medical director will Chair the Med/Surg Peer Review Committee and
oversee that the Peer Review Committee meets all applicable
regulations and legal requirements. The medical director will
facilitate and/or attend other committees including the Clinical
Quality Improvement Program Committee.
The Medical Director will be accountable for ensuring that
initiatives focused on clinical excellence and CCS clinical quality
program requirements are implemented and successfully managed to
achieve performance expectations and meet all contractual
requirements. The medial director will perform clinical quality
reviews of medical/surgical care, program integrity reviews
involving regulatory compliance, health care delivery, and other
functions to ensure that the best quality of care is provided to
Veterans who are community care beneficiaries. -This position
requires working collaboratively and closely with internal and
external partners. The medical director is expected to always
communicate effectively and professionally with internal and
external partners including the clients. Utilization management on
such tasks as concurrent review and prior authorization review may
be required in future contracts.
This position reports to the Chief Medical Officer, Community Care
Services.
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The Medical Director also provides leadership to clinical staff
through case consultation and case reviews and regularly updates
the Chief Medical Officer, CCS. The Medical Director will provide
to the Chief Medical Officer, CCS recommendations for clinical
quality program process improvements. The Medical Director is
accountable for managing resource allocation as is applicable to
medical management practices under his or her scope of
responsibility. -The Medical Director will consult with Optum Serve
Technology and Consulting Solutions as needed on CMS and other
Federal health Market consulting RFIs, RFPs, and contracts for VA
Community Care Network and will support the Chief Medical Officer,
CCS on various committees as necessary. -
You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Clinical leadership within Optum Serve and reports to the Chief
Medical Officer, Community Care Services. - -They collaborate with
the CEO, Community Care Services which has responsibility for VA
CCN
Develops, coordinates, and participates in clinical quality program
design, development, implementation, oversight, and monitoring as a
medical leader within the Optum Serve team
Works collaboratively with the Chief Medical Director, CCS and the
CCS leadership team in the development and Implementation of
clinical quality management and cost initiatives (Value Based Care)
and medical management program development
Works with the Clinical Quality team with patient safety managers,
patient safety specialists, the dental director, the behavioral
health director, and other internal partners to ensure adherence to
clinical quality performance standards
For future contracts, the Medical Director may support whole person
care (M/S and BH case and disease management) utilization
management and program integrity
Provides for and recommends clinical program enhancements and
quality improvements that adhere to the VACCN requirements and
reflect emerging clinical solutions and best evidence-based
practices
Provides clinical education to clinical staff to ensure VACCN
clinical quality program success
Accountabilities include oversight of VACCN clinical processes with
a focus on Implementing plans of care that meet accepted guidelines
and protocols and ensure that optimal and appropriate clinical
services are provided
Ensures compliance with all policies, procedures, bylaws,
regulatory requirements, and best practice guidelines
Participates in the continued implementation and any process
improvements of the VACCN clinical quality program
Oversees evaluation and management of medical practices within the
requirements of Med/Surg Peer Review Committee
Recruits and maintains participation of external actively
practicing providers and manages the Independent Review
Organizations (IRO) for specialty review when required
Ensures consistent and continual monitoring of quality of care
delivered
Provides recommendations on measures as established within VACCN
and other quality metrics such as Hospital Compare, HAC, and AHRQ
set by the VA and Optum Serve
Reviews completed charts on a regular and timely basis in
preparation for Peer Review Committee activities
Provides and receives consistent feedback on the clinical quality
of care being delivered
Assists where applicable on RFI, RFP, contracts at Optum Serve
Consulting and assisting with future growth opportunities
Other duties as assigned to support Clinical Quality, CCS and the
enterprise
You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.Required
Qualifications:
MD or DO with an active, unrestricted license
Current board certification in Internal Medicine or Family
Medicine, Surgery, Physiatry or Emergency Medicine
5+ years clinical practice experience
Demonstrated familiarity with current medical issues and
practices
Proficient understanding of Evidence Based Medicine and the
application with care and decision making
Proven ability to develop relationships with network and community
providers and VA providers
Demonstrated superb communications skills
Demonstrated excellent time management skills
Proven data analysis and interpretation skills
Proven ability to focus on key metrics
Demonstrated creative problem-solving skills
Demonstrated ability to focus on priorities
Demonstrated ability to timely and accurately complete time entries
within Costpoint and Global Self Service per company policy
Demonstrated ability to comply with all UHG and Optum employee
policies
Ability to travel less than 10%
Preferred Qualifications:
5+ years of experience in clinical quality
Experience with Veterans and/or Military medical management - -
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy
The salary range for this role is $238,000 to $357,500 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under
applicable law and qualified applicants will receive consideration
for employment without regard to race, national origin, religion,
age, color, sex, sexual orientation, gender identity, disability,
or protected veteran status, or any other characteristic protected
by local, state, or federal laws, rules, or regulations. -
OptumCare is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.
Keywords: Optum, Tustin , Optum Serve Medical Director - VA Community Care Network - Remote in US, Executive , San Diego, California
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